• Sze Ling Chan, Revvand Rajesh, and Tjun Yip Tang.
• Health Services Research Centre, SingHealth, Singapore.
• Ann Acad Med Singap. 2021 May 1; 50 (5): 411-424.

IntroductionPeripheral arterial disease (PAD) treatment guidelines recommend the use of statins and antiplatelets in all PAD patients to reduce adverse cardiovascular and limb-related outcomes. In addition, hypertension and diabetes should be treated to reach recommended targets. The aim of this rapid review was to evaluate the level of adherence to evidence-based medical therapy (EBMT) recommended by PAD treatment guidelines in the real-world setting.MethodsWe searched PubMed and Embase using keywords, MeSH and Emtree terms related to the population, exposure and outcomes from their inception to 22 September 2020. We included randomised controlled trials, non-randomised studies, and observational studies reporting adherence to at least 1 of these 4 drug classes: (1) statins, (2) antiplatelets, (3) antihypertensives and (4) antidiabetic drugs. Non-English articles, abstracts, dissertations, animal studies and case reports or series were excluded. A narrative summary of the results was performed.ResultsA total of 42 articles were included in the review. The adherence to lipid-lowering drugs/statins ranged from 23.5 to 92.0% and antiplatelets from 27.5 to 96.3%. Only 7 and 5 studies reported use of "any anti-hypertensive" and "any anti-diabetic" medications, respectively, and the proportion of the cohort treated were generally close to the proportion with hypertension and/or diabetes. Adherence in studies published in 2016-2020 ranged from 52.4-89.6% for lipid-lowering drugs and 66.2-96.3% for antiplatelets.ConclusionEBMT adherence in PAD patients was highly variable and a substantial proportion in many settings were undertreated. There was also a notable lack of studies in Asian populations.

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